The article discusses the effects that video conferencing in psychotherapy (distant therapy) may have upon the interaction between client and therapist. Experiences from distant therapy in North Norway, as well as earlier studies, are discussed in relation to factors such as client power and control, regulation of intimacy, and verbalization. The experiences indicate that physical presence--which is intuitively perceived as the ideal in relation to which the distant therapy settings are assessed--should be treated instead as a variable which can have positive and/or negative effects on a given therapeutic process.
The aim of this article is to present the qualitative focus group interview as a useful method of evaluating psycho- and milieu therapeutic treatment.
We conducted two focus group interviews with former inpatients of a psychiatric ward specialising in group therapy. To enhance the quality of the data by triangulation, the staff, representing both milieu- and psychotherapists, were also interviewed.
Analysis of the results revealed the following dominant themes: The continuation of the treatment was jeopardised by the existence of a welcome group. There was a need for further information as soon as the patient came into contact with the hospital. Moreover, an earlier and increased involvement of the family was required. After their own interview, the staff participated in deciding which results should lead to alterations in treatment procedures, thereby becoming involved in implementing the results.
The focus group interview is a valuable method of evaluating psycho- and milieu therapeutic treatment. Interviewing the staff served as triangulation and eased the implementation of the results remarkably.
Psychiatry residents in Norway have 70 hours of mandatory psychotherapy supervision to develop insights into the therapeutic relationship. Six supervision pairs (six candidates and two supervisors) conducted five videoconferencing-based supervision sessions (384 kbit/s) and five face-to-face sessions alternating weekly for 10 sessions. Following completion of the 10 sessions for candidates and supervisor B, and the 50 sessions for supervisor A, all subjects completed a semi-structured interview within two weeks. The eight subjects reported a wide range of experiences and attitudes. The results suggested that the quality of supervision can be satisfactorily maintained by using videoconferencing for up to half of the 70 hours required. The precondition for this estimate is that the pair in question have met face to face and established a relationship characterized by mutual trust and respect. Further studies, which include supervision pairs not having previously established relationships, are needed in order to indicate the generality of this precondition. The most obvious implication of this study is the potential for implementing decentralized models for recruiting and educating psychiatrists.
Interpersonal psychotherapy (IPT) has shown efficacy in randomized controlled trials. No reports exist on IPT for depressed patients with severe psychiatric comorbidities in public outpatient clinics. This pilot feasibility study assessed preliminary effectiveness and patient satisfaction with IPT for depressed patients with psychiatric comorbidities in municipal outpatient care in Turku, Finland. Because lengthy treatment strains mental healthcare resources, this trial also assessed the potential for IPT, a time-limited treatment, to discharge patients successfully.
Seven clinicians in two municipal clinics were briefly trained to deliver IPT, while clinicians in two other clinics provided treatment as usual (TAU). Twenty-six patients with moderate to severe major depressive disorder received IPT for 16 weeks, and a control group (n = 20) received TAU. Seventy-six percent of patients had concurrent anxiety disorders, 73% personality disorders and 20% alcohol dependence. As 61% of patients received concurrent pharmacotherapy, the study lacked statistical power to find outcome differences between treatment groups.
Depressive symptoms, social functioning and self-perceived health improved notably in both groups. The mean Hamilton Depression Rating Scale (HAMD) score decreased from 20 to 10. Using HAMD = 7 as a cutoff, 28.3% of patients achieved remission. Patients receiving IPT reported significantly greater satisfaction with their treatment and were more often able to terminate treatment after 16 sessions.
Both treatments were effective in this small, highly comorbid sample. Conducting IPT appeared feasible in municipal outpatient clinics and offered some advantages over TAU. It was possible to train staff quickly. These results warrant a further, larger randomized trial.
To compare the numbers of vaginal deliveries and delivery satisfaction among women with fear of childbirth randomised to either psychoeducation or conventional surveillance during pregnancy.
Randomised controlled trial.
Maternity unit of Helsinki University Central Hospital.
Fear of childbirth was screened during early pregnancy by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A). Of 4575 screened nulliparous women, 371 (8.1%) scored = 100, showing severe fear of childbirth.
Women with W-DEQ-A = 100 were randomised to intervention (n = 131) (psychoeducative group therapy, six sessions during pregnancy and one after childbirth) or control (n = 240) (care by community nurses and referral if necessary) groups. Obstetric data were collected from patient records and delivery satisfaction was examined by questionnaire.
Delivery mode and satisfaction.
Women randomised to the intervention group more often had spontaneous vaginal delivery (SVD) than did controls (63.4% versus 47.5%, P = 0.005) and fewer caesarean sections (CSs) (22.9% versus 32.5%, P = 0.05). SVD was more frequent and CSs were less frequent among those who actually participated in intervention (n = 90) compared with controls who had been referred to consultation (n = 106) (SVD: 65.6% versus 47.2%, P = 0.014; CS: 23.3% versus 38.7%, P = 0.031). Women in intervention more often had a very positive delivery experience (36.1% versus 22.8%, P = 0.04, n = 219).
To decrease the number of CSs, appropriate treatment for fear of childbirth is important. This study shows positive effects of psychoeducative group therapy in nulliparous women with severe fear of childbirth in terms of fewer CSs and more satisfactory delivery experiences relative to control women with a similar severe fear of childbirth.
The purpose of the present study was to investigate the effectiveness of cognitive-behavioural group treatment of panic disorder and agoraphobia in a clinical setting. Fifty-three patients were offered treatment and assessed before, after and at follow-up 1 1/2-2 years after treatment. The study included an informal waiting-list control group of 40 patients. The investigation group achieved better outcome on most analyses with 47.2% found to be panic-free after treatment compared with 12.5% in the control group. Treatment gains were durable with 66.7% without panic attacks at follow-up. Most patients, however, still had major psychological problems after treatment. The outcomes of cognitive-behavioural group treatment of panic disorder in this study were modest compared with most controlled studies, possibly due to an unselected patient group with a high degree of agoraphobia.
Comment In: Nord J Psychiatry. 2005;59(3):16516195115
OBJECTIVES: To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function. DESIGN: A pragmatic multicentre randomised controlled trial, stratified by centre. SETTING: Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom. PARTICIPANTS: 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Interventions: Six individual sessions of problem solving treatment (n=128), eight group sessions of the course on prevention of depression (n=108), and controls (n=189). MAIN OUTCOME MEASURES: Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function. RESULTS: 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was -2. 63 (95% confidence interval -4.95 to -0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was -1.50 (-4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome. CONCLUSIONS: When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.
There is a dearth of articles addressing psychoeducational multifamily groups for adults with intellectual disabilities. The objective of this study is to investigate the participants' experiences of being part of a group like this. The group intervention had been slightly modified due to the participants' intellectual disabilities. Four patients, their close relatives, and community professional caregivers were interviewed using a semi-structured scheme. The four patients had participated in different groups. Three of them had autism spectrum disorder in addition to intellectual disabilities and mental illness. None of the patients were in the most acute phase during the group intervention. Topics discussed in the group sessions encompassed friendship, personal economy, hygiene, understanding of mental illness, and the need for help. A basic meal was served at every group meeting. The experiences were favorable.
PURPOSE/OBJECTIVES: To better understand the common themes of women participating in an imagery program designed to improve quality of life (QOL). RESEARCH APPROACH: Qualitative. SETTING: Classroom setting at Alaska Regional Hospital in Anchorage. PARTICIPANTS: 10 women with a confirmed diagnosis of breast cancer who had completed conventional care participated in a six-class, eight-week-long imagery program titled Envision the Rhythms of Life (ERL). METHODOLOGIC APPROACH: Focus group audio recordings and notes were interpreted with the Krueger focus group method and confirmed by an outside evaluator. MAIN RESEARCH VARIABLES: Breast cancer survivors' descriptions of imagery practice and experience as they created passive, active, and targeted imagery. FINDINGS: Participants reported the importance of engaging passive and active imagery, letting targeted imagery take on a life of its own, performing homework, understanding the science, practicing, hearing imagery stories, engaging all the senses, trusting imagery, and group interaction. Imagery practice improved mood state. CONCLUSIONS: When delivered by expert imagery trainers in collaboration with oncology nurses, ERL can improve breast cancer survivors' QOL. The present study is one of few reports that evaluated survivors' imagery experiences from a clinical trial and produced significant QOL improvements. INTERPRETATION: The present study provides oncology nurses understanding of the psychological risks faced by breast cancer survivors after completion of primary care and explains the critical need for post-treatment programs for survivors dealing with post-traumatic stress disorder, depression, anxiety, or high levels of stress.
Treatment of chronic musculoskeletal pain is a challenge. 16 female patients with problems of this kind underwent a 12 week course of treatment consisting of selected physical exercises and group discussions. Twice a week a physiotherapist led indoor training to music with this group. The discussion group, which met once a week, was led by a doctor. All the participants completed the treatment. The results of the treatment were evaluated by means of talks with the patients, observation, an assessment form and five questionnaires. The participants were examined three months before treatment commenced, and immediately before and after the treatment period. The patients profited by the treatment. They expressed this opinion spontaneously during training, on the assessment form and during group discussions. It was also noticeable to us. This impression was confirmed by reduced experience of pain measured by visual analogue scale and enhanced well-being assessed by General Health Questionnaire. Exercise improved the physical condition of the participants and also induced a positive attitude to physical activity. Mutual support and the sharing of common experiences were important factors in the discussion group.